Healthcare Investigator

Job Summary

Performing detailed reviews of healthcare claims and medical records, the full-time remote Healthcare Investigator will identify potential fraud, waste, and compliance issues while collaborating with internal teams to prepare comprehensive reports and support corrective actions.

Key responsibilities

• Conduct thorough investigations of healthcare claims, medical records, and billing data to detect fraud and compliance issues
• Analyze patterns and anomalies in data, applying relevant regulations and citation guidebooks to support findings
• Collaborate with internal audit, legal, and client teams to document investigative steps and prepare clear reports

Required qualifications

• Experience reviewing medical records, claims, and billing data for accuracy and compliance
• Knowledge of healthcare regulations, including HIPAA, OIG guidance, and payer policies
• Familiarity with audit processes, including report generation and quality assurance review
• Data analysis skills with experience in identifying patterns and using relevant tools or software
• Relevant education or certification in healthcare administration, health information management, or a related field